Objectives: Migrating legacy on-premise electronic health record (EHR) systems in tertiary hospitals to modern cloud-native platforms presents technical and strategic challenges. We aimed to establish an optimized roadmap for transitioning legacy monolithic systems to a microservice architecture-based cloud-native EHR (MCEHR). Methods: We conducted a 3-month strategic assessment and case study based on the modernization requirements of a global healthcare provider. The methodology incorporated semi-structured interviews with key stakeholders, including clinical informatics officers and system architects, to identify critical pain points such as .NET 4.0 end-of-support risks and performance bottlenecks during peak clinical hours. Phased hybrid migration was adopted, analyzing over 20 TB of Oracle-based legacy data and evaluating the technical feasibility of transitioning to .NET 9 and RESTful APIs. To ensure clinical safety, a proof-of-concept (PoC) environment was developed to simulate high-concurrency clinical workloads, emphasizing system resilience and transaction integrity during intensive order-entry periods. Results: The transition to .NET 9 and MCEHR demonstrated 100% transaction integrity across 1,012 complex clinical test cases. Frontend and backend modernization showed high feasibility; however, migration of business logic embedded within legacy Oracle views represented a primary technical bottleneck, necessitating targeted decoupling. The PoC confirmed that RESTful API-based services maintained stable throughput under heavy concurrent loads, significantly reducing the risk of system-induced delays in clinical workflows. Conclusions Transitioning to an MCEHR architecture is complex but strategically essential. The proposed task force team roadmap outlines staged upgrades incorporating core technology modernization (.NET 9 and RESTful APIs), selective business component migration, and parallel DevOps adoption.

Objectives: This study aimed to evaluate the risk of major mental disorders (sleep disorder, depressive disorder, anxiety disorder, bipolar disorder, and schizophrenia) in patients with type 2 diabetes (T2D), and to compare it without T2D. Methods: A retrospective cohort study was conducted on patients with T2D (n=3,246, T2D group) and those without any type of diabetes (n=15,770, control group) who were registered in the database of Keimyung University Dongsan Hospital and standardized with the Observational Medical Outcomes Partnership Common Data Model. The incidence of major mental disorders was estimated using a multivariate Cox proportional hazards model, yielding a hazard ratio (HR) and 95% confidence interval (CI). Results: The incidence rates per 1,000 patient-years in the T2D vs. control group were 16.18 vs. 10.48 for sleep disorders, 8.75 vs. 5.80 for depressive disorders, and 6.04 vs. 4.72 for anxiety disorders. Compared to the control group, the T2D group had a higher risk of major mental disorders in the following order: sleep disorders (HR, 1.62; 95% CI, 1.36–1.91), depressive disorders (HR, 1.55; 95% CI, 1.24–1.93), and anxiety disorders (HR, 1.36; 95% CI, 1.05–1.76). There was no significant difference in the risk of bipolar disorder between the two groups (HR, 1.49; 95% CI, 0.75–2.78, p=0.23). The incidence of schizophrenia was too low in both groups to allow comparison. Conclusions T2D is an independent risk factor for major mental disorders. These findings highlight the importance of proactive mental health screening and interventions in the clinical management of diabetic patients.

Objectives: This study aims to investigate the prevalence and severity of postpartum depression symptoms in high-risk mothers following preterm birth upon discharge and to identify related factors and risk factors for these symptoms. Methods: The study retrospectively analyzed medical records of women with high-risk pregnancies who delivered premature infants (gestational age ≤35 weeks and weight <2,000 g) between January 2019 and January 2024. Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9). Results: The study included 96 mothers who gave birth to premature infants and completed both the EPDS and PHQ-9 at discharge. Mean EPDS score was 8.35±4.95, and the mean PHQ-9 score was 3.32±3.43. The prevalence of depressive symptoms and their association with various maternal and neonatal factors were analyzed. Maternal age showed a significant correlation with EPDS scores (r=0.291, p=0.004). Conclusions In this study, it was identified that high-risk pregnancies resulting in premature birth experience a considerable prevalence of depressive symptoms. Identifying related factors is crucial for early intervention and support for this vulnerable group.

Objectives: This study aims to investigate the prevalence and severity of postpartum depression symptoms in high-risk mothers following preterm birth upon discharge and to identify related factors and risk factors for these symptoms. Methods: The study retrospectively analyzed medical records of women with high-risk pregnancies who delivered premature infants (gestational age ≤35 weeks and weight <2,000 g) between January 2019 and January 2024. Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9). Results: The study included 96 mothers who gave birth to premature infants and completed both the EPDS and PHQ-9 at discharge. Mean EPDS score was 8.35±4.95, and the mean PHQ-9 score was 3.32±3.43. The prevalence of depressive symptoms and their association with various maternal and neonatal factors were analyzed. Maternal age showed a significant correlation with EPDS scores (r=0.291, p=0.004). Conclusions In this study, it was identified that high-risk pregnancies resulting in premature birth experience a considerable prevalence of depressive symptoms. Identifying related factors is crucial for early intervention and support for this vulnerable group.

Background/Aims: Functional dyspepsia (FD) has long been regarded as a syndrome because its pathophysiology is multifactorial. However, recent reports have provided evidence that changes in the duodenal ecosystem may be the key. This study aimed to identify several gastrointestinal factors and biomarkers associated with FD, specifically changes in the duodenal ecosystem that may be key to understanding its pathophysiology. Methods: In this case-control study, 28 participants (12 with FD and 16 healthy control individuals) were assessed for dietary nutrients, gastrointestinal symptom severity, immunological status of the duodenal mucosa, and microbiome composition from oral, duodenal, and fecal samples. Integrated data were analyzed using immunohistochemistry, real-time polymerase chain reaction, 16S rRNA sequencing, and network analysis. Results: Duodenal mucosal inflammation and impaired expression of tight junction proteins were confirmed in patients with FD. The relative abundance of duodenal Streptococcus (p=0.014) and reductions in stool Butyricicoccus (p=0.047) were confirmed. These changes in the gut microbiota were both correlated with symptom severity. Changes in dietary micronutrients, such as higher intake of valine, were associated with improved intestinal barrier function and microbiota. Conclusions This study emphasizes the relationships among dietary nutrition, oral and gut microbiota, symptoms of FD, impaired function of the duodenal barrier, and inflammation. Assessing low-grade inflammation or increased permeability in the duodenal mucosa, along with changes in the abundance of stool Butyricicoccus, is anticipated to serve as effective biomarkers for enhancing the objectivity of FD diagnosis and monitoring.

Objectives: This study aimed to investigate the effectiveness and safety of combining psychostimulants and nonstimulants for patients under treatment for attention deficit hyperactivity disorder (ADHD). Methods: The study included 96 patients aged 6–12 years who were diagnosed with ADHD, among whom 34 received combination pharmacotherapy, 32 received methylphenidate monotherapy, and 30 received atomoxetine monotherapy. Statistical analysis was conducted to compare treatment and adverse effects among groups and to analyze changes before and after combination pharmacotherapy.The difference between combination pharmacotherapy and monotherapy was investigated. Logistic regression analysis was used to identify the predictors of combination pharmacotherapy. Results: No significant differences were observed between the groups in terms of age or pretreatment scores. The most common adverse effect experienced by 32% of patients in the combination pharmacotherapy group was decreased appetite. Clinical global impression-severity score decreased significantly after combination pharmacotherapy. All three groups showed significant clinical global impression-severity score improvements over time, with no significant differences among them. The predictive factors for combination pharmacotherapy included the Child Behavior Checklist total score internalizing subscale. Conclusion Combination pharmacotherapy with methylphenidate and atomoxetine is a relatively effective and safe option for patients with ADHD who do not respond to monotherapy.

Objectives: This study aims to investigate the prevalence and severity of postpartum depression symptoms in high-risk mothers following preterm birth upon discharge and to identify related factors and risk factors for these symptoms. Methods: The study retrospectively analyzed medical records of women with high-risk pregnancies who delivered premature infants (gestational age ≤35 weeks and weight <2,000 g) between January 2019 and January 2024. Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9). Results: The study included 96 mothers who gave birth to premature infants and completed both the EPDS and PHQ-9 at discharge. Mean EPDS score was 8.35±4.95, and the mean PHQ-9 score was 3.32±3.43. The prevalence of depressive symptoms and their association with various maternal and neonatal factors were analyzed. Maternal age showed a significant correlation with EPDS scores (r=0.291, p=0.004). Conclusions In this study, it was identified that high-risk pregnancies resulting in premature birth experience a considerable prevalence of depressive symptoms. Identifying related factors is crucial for early intervention and support for this vulnerable group.

We investigated the incidence of diagnosed diabetes in South Korean adults (aged ≥20 years) by analyzing data for the National Health Insurance Service–National Sample Cohort. From 2006 to 2015, the overall incidence rate of diagnosed diabetes decreased by approximately 0.1% per year until 2015. Although, this trend was observed in individuals aged 40 years or over, the rate increased slightly in the 20–29 and 30–39 years age groups, from 0.5 to 0.7 and 2.0 to 2.6 per 1,000 individuals, respectively. The proportion of obese young adults with diabetes increased remarkably, from 51.4% in 2006 to 72.4% in 2015. Thus, young adults need early identification and weight-control strategies to prevent diabetes.

Objectives: ：The aim of this study was to investigate the factors associated with changes in depression severity in index electroconvulsive therapy (ECT) for major depressive disorder. Methods: ：A retrospective analysis was performed on 80 patients with major depressive disorder who received index ECT. The severity of depression was assessed using the Hamilton depression rating scale-17 (HDRS-17). Multiple linear regression analysis and logistic regression analysis were performed to identify the factors associated with the change of depression severity and the predictors of the 50% or greater reduction rate of HDRS-17. Results ：55 (68.8%) patients were HDRS-17 score change ≥50% group, and 25 (31.2%) patients were HDRS-17 score change <50% group. HDRS-17 score change ≥50% group had a shorter episode duration before ECT (11.91±8.63 vs 17.68±11.15 weeks, p=0.027) and more ECT sessions (8.60±2.91 vs 6.80±3.34 sessions, p=0.017). The higher baseline score of anxiety (B=0.937, β=0.374, p<0.001), depression (B=0.846, β=0,324, p=0.001), and somatic symptom (B=0.995, β=0.210, p=0.031) dimensions was associated with the change of HDRS-17 score from baseline. The longer episode duration until the start of ECT was associated with lower likelihood of HDRS-17 score change ≥50% (Wald χ2 =7.74, OR=1.08, 95% CI: 1.02-1.14, p=0.005). The greater number of ECT sessions predicted the HDRS-17 score change ≥50% (Wald χ2 =7.85, OR=0.75, 95% CI=0.62-0.92, p=0.005) Conclusions：In higher baseline anxiety, depression, and somatic symptoms severity, implementing sufficient sessions of ECT in pharmacological treatment phase of relatively shorter duration of major depressive episode may help reduce HDRS-17 score.

Objectives: ：A growing body of evidence links type 2 diabetes (T2D) with a neurodegenerative disease (ND) such as Alzheimer’s disease and Parkinson’s disease. The purpose of this study is to investigate the relationship between NDs and the development of T2D by comparing the incidence of T2D in a group of various NDs (ND group) and control group. Methods: ：A population-based 10-year follow-up study was conducted using the Korean National Health Information Database for 2002-2015. We used a retrospective cohort study design to investigate the association of ND with T2D occurrence. The study population included ND (n=8,814) and control (n=37,970) groups, all aged 60 years or over. The Kaplan-Meier method was used to estimate the risk of developing T2D as a function of time. Cox proportional hazards regression models were used to evaluate the relationship between ND and T2D. Results: ：T2D was developed in a significantly higher percentage of patients in the ND group (53.6%) than in the control group (44.7%). The ND group increased the risk of T2D (HR, 1.43; 95% CI, 1.38-1.47). About onethird of patients in both groups were additionally diagnosed with another ND before the occurrence of T2D during a 10-year follow-up period. When compared to those who did not have another ND during the follow-up period, the incidence of T2D in those who were additionally diagnosed with another ND was higher in both the ND and control groups. Conclusions ：The ND group had about 1.4 times higher risk of developing T2D than the control group. Our results showed a positive association between ND and T2D.